Reevaluation of the surgical indications for anterior inferior iliac spine avulsion fractures in an acute setting – A narrative review of the current literature

Purpose: The anterior inferior iliac spine (AIIS) is a frequent site of avulsion fracture in the pelvis, and these lesions could be observed mainly in teenage athletes. The present study aimed to re-evaluate the appropriate acute surgical treatment of AIIS avulsion fractures considering the three-dimensional anatomy of the supracetabular region. Methods: This study evaluated current evidence of AIIS avulsion fracture treatments and outcomes. A literature search was done in the following databases: PubMed, SCOPUS, Embase, and Cochrane Library. All relevant information was used in this review. Results: Several studies have shown how conservative treatment of these injuries lead to excellent outcomes, even when there is radiological evidence of displacement. However, only some surgeons describe clinical and radiological follow-up beyond six months. On the other side, recent studies have demonstrated the efficacy of arthroscopic or open procedures to solve a frequent cause of extra-articular femur-acetabular impingement (FAI) syndrome associated with previous AIIS avulsion fractures, the so-called sub-spine impingement. The acute surgical indication in AIIS avulsion fractures should be considered according to the three-dimensional anatomy of the supracetabular region, especially in young patients with high functional demands. Conclusions: Three-dimensional assessment allows accurate evaluation of the position and dislocation of the fragment, predicting the risk of complications related to conservative treatment and guiding toward surgical indication only when appropriate.